title: Continuity of care in a rural critical access hospital: surgeons as primary care providers.
abstract: BACKGROUND
  The question of volume and outcomes has perfused the surgical literature. Hopedale Hospital is a critical access hospital located in central Illinois. The authors elected to review surgical outcomes to establish quality benchmarks for similar facilities. They also propose a practice model in which general surgeons provide primary care.
  
  
  METHODS
  The authors consecutively reviewed retrospectively 100 each of 5 commonly performed procedures. These included carotid endarterectomy, laparoscopic cholecystectomy, laparoscopic Nissen fundoplication, hysterectomy, and inguinal hernia repair. Demographic data, c-morbidities, and outcomes up to 30 days postoperatively were summarized.
  
  
  RESULTS
  The overall complication rate was 4%. This exceeded any benchmarks found in a surgical literature review through Medline.
  
  
  CONCLUSIONS
  Critical access hospitals are capable of producing excellent surgical outcomes. Having a surgeon totally involved in perioperative management may contribute to the improved outcomes. This practice model could be used to recruit medical students into surgical training, perhaps alleviating shortages of rural surgeons and primary care physicians simultaneously.
authors.affiliation: Hopedale Medical Complex, Hopedale, IL, USA. arossi@pol.net
authors.forename: Alfred
authors.initials: A
authors.lastname: Rossi
authors.forename: Daniel
authors.initials: D
authors.lastname: Rossi
authors.forename: Mathew
authors.initials: M
authors.lastname: Rossi
authors.forename: Phillip
authors.initials: P
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends; D003422:Critical Care; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D018662:Fundoplication / Q000009:adverse effects; D006552:Hernia, Inguinal / Q000601:surgery; D006780:Hospitals, Rural; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007087:Illinois; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D011320:Primary Health Care; D013503:Surgery Department, Hospital; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D016896:Treatment Outcome; D000078329:Workforce